The Osteotomy And Medial Migration Of Inter-orbital Wall, And The Implantation Of The Medpor Into The Lateral Wall Of Orbit To Correct The Orbital Hypertelorism

Orbital hypertelorism is a congenital condition in which the inter-orbital distance is wider than normal. Orbital hypertelorism is a sign, not a diagnosis of a deformity and is found in craniofacial congenital clefts, as described by Tessier 0-14. It is also found in some congenital syndromes such as Apert's or Crouzon's syndrome. This disease was found and named by Devid Greig in 1924. Paul Tessier reported his first intra-extra cranial approach operation for orbital hypertelorism correction in 1968, with some defects in the approach such as postoperative hemorrhage, leakage of cerebrospinal and postoperative recurrence. During the following 40 years, this method to correct the orbital hypertelorism has been improved gradually.Objective:Through the complete dissection to soft tissue inter and around of orbital bone, the osteotomy and medial migration of medial orbital wall, and the implantation of the medpor into the lateral wall of orbit to correct the hypertelorism and reduce the rate of postoperative recurrence.Material and methods:There were 2 male patients (18 years and 20 years) with orbital hypertelorism accepted this kind of operation. The method of the operation is the same, that is "the osteotomy and medial migration of medial orbital wall, and the implantation of the medpor into the lateral wall of orbit to correct the hypertelorism". Before the operation, we measured the IOD(40mm 46mm), the distance of the inner canthus is 5.5cm and 6.0cm.Results:Both of the patients have a good result, All the wound cure well. There are not complications in the approach such as postoperative hemorrhage, leakage of cerebrospinal, vision loss and infection. The mobility of the eye ball is good. The implanted medpor is stable (no rejection and exposure). After the operation we measured the IOD, there are 28mm and 30mm, the appearance of the patients is improved well. Conclusions:Orbital hypertelorism correction is a modification to the traditional Osteotomy for inter-orbital wall. It includes the osteotomy and medial migration of medial orbital wall, and the implantation of the medpor into the lateral wall of orbit to correct the hypertelorism. One point of its innovation is the introduction of the new material medpor and the other is the osteotomy method of inter-orbital wall. Medpor has been applied in craniofacial surgery for more than two decades. Many clinic studies showed that compared to other implanted materials, medpor has its unique advantages. The osteotomy of Medial orbital wall reserves the medical bone. And most importantly, it leaves the space for globe malposition by adequate osteotomy and compression fracture to the plate of ethmoid bone without injuring the optic nerves and lacrimal sac. In 2008 and 2009, this approach has been applied to two cases and achieved satisfactory clinic-results.